Noscapine
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Noscapine is a naturally occurring opium alkaloid used as a non-narcotic cough suppressant (antitussive) in some countries.
- It suppresses the cough reflex centrally.
- Unlike morphine or codeine, it has little to no analgesic effect, does not usually cause respiratory depression at usual doses, and has low dependence potential.
- Common adverse effects can include drowsiness, dizziness, nausea, and headache.
- Use cautiously with sedatives or alcohol, and avoid self-medicating a persistent cough without identifying its cause.
- Availability varies by country. Katzung notes that noscapine is not available in the United States.
It is an opium-derived compound, but it is not used as an opioid painkiller.
Dextromethorphan
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dextromethorphan FDA label contraindications MAOI serotonin syndrome
Dextromethorphan (DXM) is an over-the-counter cough suppressant used for a dry, irritating, nonproductive cough.
- Action: suppresses the cough reflex in the brain. At normal antitussive doses, it is not an analgesic and is not expected to cause opioid-like respiratory depression.
- Common adverse effects: nausea, dizziness, drowsiness, and vomiting.
- Do not combine with MAO inhibitors or use within 14 days of stopping one. The combination can cause severe interactions, including serotonin syndrome. Use caution with serotonergic medicines such as SSRIs/SNRIs, tramadol, and some migraine medicines. See the FDA labeling warning.
- Avoid double-dosing: many “cold and flu” combination products already contain DXM. Check the active-ingredient list.
- At high doses, DXM and its metabolite dextrorphan can block NMDA receptors and cause dissociation, hallucinations, agitation, and potentially dangerous toxicity. It should not be used recreationally.
- Seek medical advice for cough with breathlessness, chest pain, bloody sputum, high fever, wheezing, or persistence beyond about 1 week.
DXM is also used in specific prescription combinations, including dextromethorphan-quinidine for pseudobulbar affect and dextromethorphan-bupropion for major depressive disorder. Recent reviews address these non-cough uses, including DXM-bupropion in depression.
Katzung’s Basic and Clinical Pharmacology, 16th Edition, antitussives section.
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